Xiao Wu, Christina Mullikin

New England School of Acupuncture, Massachusetts College of Pharmacy and Health Sciences University

Abstract

Long COVID refers to the continuation or development of lingering or new symptoms three months after the initial coronavirus infection. The most common symptoms are fatigue, and shortness of breath. Research has shown that approximately 10-30% of people who have had COVID-19 have these symptoms. Long COVID has impacted socioeconomic and healthcare systems in the United States (U.S.) and all over the world in many ways. The pathological changes and treatment guidelines for Long COVID are still not clear. Many states have integrated complementary and alternative medicine (CAM) in their health care services. CAM treatments have improved patients’ symptoms and boosted their immunity. With effort and support from healthcare providers and policies, CAM has the potential to shed light on the patients who suffer from long COVID.

Introduction

History repeats itself! When the COVID- 19 virus swept around the world, the parallels with the 1918 flu pandemic were obvious. It was estimated that 675,000 Americans lost their lives in the 1918 pandemic (Taubenberger & Morens, 2008). As of this writing COVID-19 has taken more than 1.1 million lives in the U.S. (CDC, 2023), and, while waves of COVID-19 have already affected the majority of countries, the impacts of COVID-19 are still evolving with the problems of ‘Long COVID’ or ‘post-COVID-19’ .

Long COVID or post-COVID-19 refers to the continuation or development of lingering or new symptoms three months after the initial infection (Shah et al, 2021). The most common symptoms are fatigue and shortness of breath. Other symptoms may include cognitive challenges and difficulty concentrating, depression, headaches, sleep problems, smell and taste dysfunctions, joint or muscle pain, gastrointestinal, and cardiac issues (Yong, 2021). Research has shown approximately 10-20% of people who have had COVID-19 have these symptoms (Cheung et al, 2020) (Mao et al, 2020). The chances of long COVID increases to more than 30% in patients who require hospitalization during the course of the initial illness. Long COVID is far more common than many think, as it affects people’s ability to resume normal life activities. Previously healthy people may become disabled. The COVID-19 pandemic and Long COVID have placed a substantial strain on the healthcare systems in the United States, and the rest of the world.

Long COVID and Healthcare Inequities

The COVID-19 pandemic has highlighted and exacerbated the health inequities that already existed in the U.S. The beginning of the COVID-19 pandemic demonstrated the healthcare disparities in certain racial/ethnic and socioeconomic status (SES) groups. For example, women of color and with children faced the challenges of financial and job insecurity with a higher rate of morbidity of COVID-19 (Aleksanyan & Weinman, 2022) (Kalinowski et al, 2022). People of low SES were more likely to live in overcrowded communities which makes it challenging to follow social distancing guidelines. The infectious disease easily spreads. Without secure jobs and healthcare, they tended to have worse outcomes from COVID-19 infections, which makes the development of Long COVID more likely (Patel et al., 2020).

The rates of long COVID are higher in women (Perlis.et al.,2022), Black and Latinx populations (Berger. et al., 2021). Many social determinants of health such as SES, physical environment, and occupation can have strong effects on the progression of COVID-19. Long COVID has a negative shift in the social determinants of health (Russo et al., 2021). Effective interventions are needed to treat patients so as to reduce the negative health impacts of structural racism in health systems, and health policies and programs on racial and ethnic minorities and populations experiencing social disadvantage.

Long COVID and the Healthcare system

The COVID-19 pandemic has pushed the healthcare system to its limits, straining both global health security (GHS) and universal health coverage (UHC) type systems (Lal et al., 2021). GHS aims to strengthen the national and international capacity of preventing, detecting and responding to public health threats, especially infectious diseases. UHC focuses on providing health security and universal access to comprehensive and quality care without financial burden (Wenham et al, 2019).

The pandemic began in early 2020, constituting an unprecedented challenge to healthcare, socio-economic and political systems worldwide.

Despite the U.S. receiving top ratings for the pandemic in the GHS Index, the country suffered high rates of healthcare worker burnout, exhaustion and trauma, supply shortages, and resource maldistribution (Lal et al., 2021). Despite the U.S. being the most advanced country in medicine and having the highest Gross Domestic Product (GDP), it is also the current number one country for the COVID-19 cases and deaths per capita. Meanwhile, The U.K., with a well-developed UHC, showed the UHC’s limitations during the historic pandemic, not acting quickly to ensure an effective National Health Service response (Wenham, 2020). Because of the fragmented health systems in the COVID-19 pandemic, long COVID was reported with a prevalence of 10% to 15% in the U.K. a similar rate to the U.S. (Castro et al., 2022). However, countries with integrated health systems of GHS and UHC, such as South Korea and Taiwan, effectively controlled and prevented the COVID-19 pandemic (Normile, 2020).

Long COVID and Health Care Access as well as Insurance Coverage

Long COVID includes a wide range of medical problems that can last weeks, months, or years, significantly impacting one’s life and work (Fugazzaro et al., 2022), (Walle-Hansen et al., 2022). Medical management and healthcare support can improve the quality of life for these patients.

Healthcare access is the ability of an individual to obtain health care when needed. In the U.S., access is restricted to people who either have insurance coverage from employers or sponsored by governmental healthcare programs, such as Medicare, Medicaid, and the Affordable Care Act (ACA). In general, if one already has health insurance, it will continuously cover their health care for long COVID. For employer-sponsored health insurance, if one is too sick to work, they cannot maintain their coverage. Fortunately, there are provisions that protect people’s continued access to health care benefits and coverage in this situation through the Family and Medical Leave Act (FMLA), which provides leave or disability benefits for those who are eligible (Kröönström. et al., 2022).

In some special conditions, for example, when one’s current insurance might not cover all of expenses related to the treatment of long COVID, the ACA guarantees the right to appeal. There is no guarantee that your insurance plan will fully or partially cover your prescribed medications for the treatment of long COVID.

Long COVID and integrative approaches for patient care

Studies have indicated that the long COVID may be a looming public health crisis (Phillips & Williams, 2021). As health care practitioners, what can we do to help patients. The pathology of long COVID is not understood, nor is how long it takes for patients to recover from the condition. By involving broad healthcare perspectives, some patients have formed online groups to share information and support each other. Many states have integrated complementary and alternative medicine (CAM) in the health care services (Kim et al, 2022) (Roth et al, 2021). CAM and acupuncture interventions have improved symptoms and boosted immunity.

In our clinic, we have encountered patients with Long COVID symptoms including headaches, insomnia, and irritable bowel syndromes, etc. With acupuncture and Chinese herbal medicine treatments, we have helped many patients recover. As we understand, patients with health insurance coverage have less financial stress and have better outcomes.

As we discussed, minorities including women, Black and Hispanic populations, have been disproportionately affected in the pandemic. For the complex clinical needs of these patients, health systems and practitioners need to make more efforts.

Summary

Long COVID is a chronic illness affecting the physical and mental health of millions of Americans. It is also a pervasive economic burden which may continue for decades. The World Health Organization, health policy makers, and healthcare providers have worked together to face the challenges. As Wall Street Journal described, “Treating people with long COVID comes with a cost that will fall to some extent on patients and their families and to some extent on society” (Krause, 2022). We believe that we can manage Long COVID well as we have finally controlled the surges of the COVID-19 pandemic.